MacroHealth Newsletter

No. 4 May 2003

Country action.....Country action.... Country action.....Country action....

The WHO Regional Office for the Eastern Mediterranean is promoting the concepts of the CMH Report among the countries of the Region and is planning a regional position paper on the recommendations and findings of the report. The Regional Office suggests that consideration has to be given to lessons learnt from the implementation of the World Development Report 1993 and considers this critical for generating the support needed from donors and other stakeholders. The challenge this time would be to ensure that countries succeed in raising sufficient resources to achieve the desirable health outcomes. The Regional Office also proposes that country responses to the Commission's recommendations must be linked to other WHO initiatives such as Country Focus Initiative and Country Cooperation Strategy, as well as with existing national mechanisms such as Poverty Reduction Strategy processes and Sector Wide Approaches (SWAps).

Meeting to facilitate CMH implementation in the Eastern Mediterranean

A meeting will be convened by WHO's Eastern Mediterranean Regional Office and HQ in Fez, Morocco, 13-14 June 2003. Country, Regional and HQ WHO staff will come together to finalize CMH national plans for the countries of the Region and debate CMH recommendations in an effort to prepare a regional macroeconomics and health concept paper. This will be used as a template to guide and assess country-level activities region-wide. The objectives of the meeting will be to review CMH follow-up plans at country level and progress to date, develop strategic plans of action, and discuss the Second Consultation on Global and National Responses to the Commission on Macroeconomics and Health Report that will take place in October this year.

More meetings to finalize macroeconomics and health planning

WHO's two Regional Offices and HQ are organizing two meetings to finalize Macroeconomics and Health action plans for the countries of the African and South-East Asian Regions. The meetings in the two WHO Regions are scheduled for the summer of 2003.

European task force established

The Regional Director of WHO's European Office has set up a CMH Task Force to review the findings of the CMH Report and suitability of approaches for the countries of the European region. The Task Force will explore the most appropriate ways of providing follow-up to the CMH Report in the region and will complete its in-depth analyses by April 2004. Specific attention will be given to strengthening the capacity of health systems to improve the health outcomes for the poor in strong, weak and fragile economies, as well as economies in crisis. The Task Force will focus on: 1. Why a European Report on Macroeconomics and Health. 2. Health, poverty trends and the level of indebtedness in the European Region. 3. The non-financial constraints to health systems, and 4. Addressing the determinants of population health in Europe.

WHO's regional office for South-East Asia active in CMH work

WHO South-East Asian Regional Office has published a report on the Regional Conference of the Parliamentarians in December 2002 focusing on the CMH Report. The 19-page Report of February 2003 outlines the main CMH themes discussed during the meeting, recommendations for action and key speaker presentations. To request information on the Regional Conference of the Parliamentarians Report please visit : http://w3.whosea.org/pub/doclists.htm

In April this year, the Regional Office finalized the Country Guidelines for CMH follow-up and a related document, Outline for a Strategic Framework and Investment Plan. Both documents have been forwarded to all WHO country offices of the Region to encourage and facilitate the production of national CMH workplans and institutional mechanisms to carry forward CMH work by the summer of 2003. The guidelines can be adapted to suit national conditions and individual government structures, and the Regional Office has offered to assist national authorities develop their macroeconomic and health workplans.

Macroeconomics and health meeting in Estonia

On the occasion of the tenth anniversary of Estonia's membership of WHO in March this year, a Macroeconomics and Health presentation was made to some 70 participants, including the Minister of Social Affairs and his officials, the Ministry of Finance, representatives from international organizations, health institutions and the Academy of Estonia. The event offered the opportunity to confirm the Government's interest in the macroeconomics and health approach and to have meaningful discussions, with health authorities and Nordic country representatives, on the relevance and possibilities for follow-up of CMH work in Estonia. Though Estonia is a middle-income country on the road to economic development, the overall health status of its population is poorer than in EU and Nordic countries. There are marked health inequalities, and health still needs to be incorporated in the country's political debate.

Macroeconomics and health workshop in Ethiopia

The Ethiopian Annual Review Meeting of the Health Sector Development Programme II (HSDP) took place in Nazareth in April this year. In a CMH workshop, senior Government participants heard about macroeconomic and health concepts and how this approach could accelerate the implementation of HSDP II, the Sustainable Development and Poverty Reduction Programme, support the Woreda (district) decentralization process, and contribute towards the Millennium Development Goals. The CMH process is already generating awareness of the important links between health and economic development among key target audiences. The aim of the CMH process in Ethiopia is to accelerate the implementation of existing health sector initiatives through supporting capacity building activities critical for achieving HSDP II goals and to assist the government with applied research necessary for health policy development.

Health now a high priority in Indonesian national development agenda

Six Indonesian parliamentarians participated in the South East Asian Regional Conference of Parliamentarians dedicated to the CMH report, in December last year. This meeting had a positive impact on government decision-makers and contributed significantly to a number of important national initiatives that promote health within the national development agenda. One of these is the Consultative Group on Indonesia (CGI), chaired by the World Bank and the Coordinating Minister for Economic Affairs, which has included health on its agenda. WHO was nominated co-chair of the CGI health working group, which has already developed a conceptual background paper, a long-term matrix of activities to be completed within a 2-3 year timeframe, and a workplan for 2003 focusing on health and poverty.

Through the CGI Health Working Group, the Government of Indonesia and the international donor community in health have agreed upon a long-term goal, purpose and six objectives to achieve pro-poor, health commitments. These are:

Reduce financial vulnerability to major medical expenses and protect the interests of the poor.

Optimize the participation of private and NGO providers in contributing to implementation of national health priorities, including services for the poor.

Improve governance and ensure an effective institutional environment under decentralizations to support pro-poor health programmes.

Ensure access to affordable and quality services, especially for the poor.

Ensure accountability by local government for health systems at all levels by engaging a broad range of stakeholders, including the poor.

In addition to supporting the efforts of the CGI health working group, the WHO country office is widely disseminating the CMH Report's findings to decision-makers through translation of the CMH executive summary and production of various CMH-related advocacy materials. The WHO country office envisions the establishment of a Centre focusing on research and advocacy on health as a means of poverty reduction. The Centre has set up a group charged with: identifying critical advocacy information and data about inequities in health; developing advocacy materials; implementing relevant seminars targeting parliamentarians, and other senior Government decision-makers; promoting health issues within major Indonesian media; advancing the CGI health working group workplan and integrating health into the PRSP process; and introducing international experiences in the Government's poverty reduction agenda.